Kryotherapie als Analgesietechnik in der direkten, postoperativen Behandlung nach elektivem Gelenkersatz

Abstract

The application of crushed ice or hydrogenated silicate, a micro-crystalline substitute has been used as a method to treat posttraumatic and postoperative irritations of the locomotor system for a long time. Closed systems using pumps can be viewed as further development as they enable continuous, water-free cooling of operating areas. The analgetic effect of postoperative cold therapy was evaluated in a prospective clinical trial, including 312 patients after total knee or hip arthroplasty. Conventional cold packs, consisting of microcrystalline silicate were compared to a continuous applicable closed system. Continuous cryotherapy resulted in a depression of skin temperature to 12 degrees C, whereas intermittent cooling only caused a mean temperature decrease of 1 degree C. Clinically continuous cold application leads to a more than 50% decrease of analgetic demands in both, systemic and regional application (p < 0.001). This observation was found in a significant correlation with patient's pain sensation as well as primary range of motion. Intermittent cryotherapy was found to be ineffective in postoperative pain relieve in hip- and adequate in knee arthroplasty patients. We could not report an influence on postoperative blood loss, as discussed in previous reports.

Cryotherapy on postoperative rehabilitation of joint arthroplasty

“…Characteristics of the 12 included studies [2, 9, 13–16, 19, 26, 27] are listed in Table 1. The quality scores attributed to each study according to Jaded scale are described in Table 2.…”

“…The form of control and intervention was different: seven studies compared an intervention that included cryotherapy and compression to compression alone [9, 14, 15, 19, 21, 23, 27]. Two studies compared an intervention including cryotherapy and continuous passive motion (CPM) to CPM alone [2, 26]. Two studies compared only cryotherapy to nothing [16, 22].…”

“…The cryotherapy of included 11 studies [2, 9, 13–16, 19, 21, 22, 26, 27] was applied by professional cryotherapy device. The time and temperature were adjusted by instruction of each cryotherapy device.…”

The Effect of Cryotherapy Application on Postoperative Pain

“…The 51 RCTs included N = 3425 postoperative patients; 42 (82.4%) trials investigated cryotherapy to no cryotherapy application, 23 ' 26-66 and 9 (17.6%) included multiple arms which compared different modalities of cryotherapy to no cryotherapy (Supplemental Digital Content Table 2, http://links.lww.com/ SLA/D554). 24 ' 25 ' [67][68][69][70][71][72][73][74] Of included trials, 18 (35.3%) trials were conducted in North America, 17 (33.3%) were conducted in Europe, and 16 (31.4%) were conducted in Asia. All trials were published between 1989 and 2020.…”

The efficacy of continuous-flow cryo and cyclic compression therapy after hip fracture surgery on postoperative pain: design of a prospective, open-label, parallel, multicenter, randomized controlled, clinical trial

“…A trend towards lower visual analogue scale (VAS) pain scores and less morphine use was observed, and patients receiving continuous-flow cryocompression (CFC) therapy had statistical significant less decline in postoperative hemoglobin levels. In two randomized controlled trials evaluating continuous-flow cryotherapy (without a compression adjunct) in 45 total hip [ 37 ] and 208 total hip and knee arthroplasty [ 38 ] patients, lower pain scores were observed and less morphine was used. Furthermore length of stay was 1.4 days shorter when continuous-flow cryotherapy was applied after hip arthroplasty in 74 patients [ 39 ].…”